Active NPI
Jae S Kim, M.D.
- Cardiovascular Disease Physician
- Orlando, FL
National Provider Identifier
1396769519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- ME0041878
- Practice address
- 5840 W Colonial Dr
Ste 1
Orlando, FL 32808-7558 - Phone
- (407) 767-8554
- Fax
- (407) 767-9121
- NPI assigned
- Jul 27, 2006
- Last updated
- May 13, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | ME0041878 | FL | Primary |
Addresses
Primary practice location
5840 W Colonial Dr
Ste 1
Orlando, FL 32808-7558
Mailing address
5840 W Colonial Dr
Ste 1
Orlando, FL 32808-7558
Phone (407) 767-8554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 067741800 | Medicaid | FL |
Other names 1
- Jae Suk Kim
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0041878 | FL | MD | Cardiovascular Disease Physician |
| 41878 | FL | MD | Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368403200000",
"number": "1396769519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5840 W COLONIAL DR",
"address_2": "STE 1",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328087558",
"telephone_number": "407-767-8554",
"fax_number": "407-767-9121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5840 W COLONIAL DR",
"address_2": "STE 1",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328087558",
"telephone_number": "407-767-8554",
"fax_number": "407-767-9121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2013-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "FL",
"license": "ME0041878",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "067741800",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JAE",
"last_name": "KIM",
"middle_name": "SUK",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.